Technical approaches toward ambulatory ESRD therapy

Current efforts to prolong dialysis and make it ambulatory may, but need not, follow the established countercurrent contact of blood and dialysate through a membrane. Avoiding anticoagulation and addressing decremented performance of membranes used over long times suggests gentler blood contact and greatly reduced contact areas. This paper describes a microfluidic fluid-to-fluid contact system, still under development, and suggests that initial attempts at ambulatory support of end-stage renal disease patients may be limited to interdialytic volume control, perhaps with a reduced frequency of dialysis which would then be used only to remove accumulated solutes.